The Department of Justice announced on June 30, 2011 that a Las Vegas physician, Rakesh Nathu, settled False Claims Act allegations with the United States for $5.7 million plus interest. Nathu allegedly submitted false claims to Medicare, TRICARE and the Federal Employees Health Benefits Plan for various radiation oncology services from 2007 to 2009. Allegations […]
Prior to the passing of section 102(a)(1) of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (“PACMBPRA”), the 3-day payment window policy for nondiagnostic services provided prior to admission was rarely applied to wholly owned or operated physician practices. However, the enactment of section 102(a)(1) widened the range […]
On June 30, 2011, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule which eliminates the requirement that physicians and non-physician practitioners must sign requisition forms for clinical diagnostic laboratory tests. The original policy was established by the final 2011 Medicare Physician Fee Schedule, but it was placed on hold earlier this […]
Federal law enforcement officials announced on June 29, 2011 that Jacinto “John” Gabriel, Jr., a Chicago man responsible for operating two home health care businesses, was indicted in an alleged $20 million Medicare fraud scheme spanning five years. The 15-count indictment includes health care fraud, wire fraud, and money laundering. According to court documents, Gabriel […]
The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule regarding the 2012 Medicare Physician Fee Schedule on July 1, 2011 (“Proposed Rule”). Among the potential changes found in the Proposed Rule is a 50 percent discount to the professional component (“PC”) of subsequent MRI, CT, and ultrasound procedures. This proposed change mirrors […]
The Senate Finance Committee abandoned the proposed increase to the Medicare utilization rate assumption for advanced diagnostic imagining equipment priced at $1 million or more. The potential rate hike was included as a provision in a proposed free trade agreement and was meant to pay for health care benefits and job training for U.S. workers […]
On June 23, 2011, the Departments of Justice and Health and Human Services announced that, under the aegis of the inter-agency Health Care Fraud Prevention and Enforcement Action Team (HEAT) program, three employees of the Solstice Wellness Center, a Brooklyn-area clinic that purported to specialize in providing physical therapy and diagnostic tests, have pleaded guilty […]
By correcting vulnerabilities identified by Recovery Audit Contractors (“RACs”) and similar Medicare contractors, the Centers for Medicare and Medicaid Services (“CMS”) hopes to reduce the rate of mistakes uncovered by the Comprehensive Error Rate Testing (“CERT”) program. Diagnosis Related Group (“DRG”) Validation review is one of the processes RACs utilize to review Medicare claims submitted […]
On June 29, 2011, the 6th Circuit Court of Appeals upheld a lower court’s ruling on the health reform law’s requirement that nearly all Americans buy insurance. The three-judge panel, including two Republican nominees, ruled 2-1 in favor of the mandate. The original suit was brought by the Thomas More Law Center, which argued that […]
A shortage of primary care doctors has long concerned health policy experts, and the deficiency could grow even more severe if health insurance coverage is extended to more than 30 million Americans as expected under the new health care law. In response to the issue, the Obama administration began recruiting individuals to become “mystery shoppers” […]
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